Quick poll: in all the writing you’ve been reading recently about art and mental health (like this recent Exeunt article, and this one, and from a bit further ago this one), how much have you encountered mention of neurodiversity? The Venn diagram of depression, anxiety and the myriad conditions labelled disorders, not just bipolar or borderline personality but autism and aspergers and obsessive compulsive, is vast and complex with plenty of crossover, but it’s only crescents of each circle that get illuminated in wider cultural discussion, and some not at all. For Salford company Art with Heart, the overlaps are personal and critical: its new show, Declaration, is performed by co-creative director Sarah Emmott and tells of her realisation three years ago, at the age of 30, that she had been living with undiagnosed attention deficit hyperactive disorder (ADHD), struggling to cope with all the “self-doubt and anxiety” that her difference from others provoked.

Declaration is an attempt to counteract aspects of British culture that Emmott and her company’s co-director, Rachel Moorhouse, see as detrimental. “We’re not very good at saying I don’t feel OK, unless it’s something you can prove,” says Emmott. “A lot of people aren’t comfortable in articulating feelings and that’s often where it’s come from, but you don’t want to mither people when it’s something you can’t show.” The result, says Moorhouse, is that workplaces tend to support physical needs but not mental ones: “If you are pregnant or have a bad back they will get you a different chair – but never in the process of recruitment or regular meetings are you asked what you need to make you more comfortable. Do you need a space that doesn’t have loud noises? Do you actually need music? Do you need regular breaks? How can workplaces do that?”

The duo might not have answers for the wider work culture, but in the making of Declaration they have come up with plenty for the theatre industry – which is remarkably poor at supporting neurodiversity. How many theatres have a dedicated mental health first aider? How many offer visiting artists well-being support or even a point of contact beyond the technical team? How many rehearsal rooms take autism into account? These are all questions being brought into view by artists and theatre-makers: for instance, in January this year, Chris Goode led a session at Devoted & Disgruntled dedicated to thinking about how theatres might better care for touring artists, followed in May by a satellite event led by Griffyn Gilligan focusing on how making practices might be adapted to include artists with ASD more fully. In the months ahead Daniel Oliver, Ellie Griffiths and Greg Sinclair will be leading workshops with the Live Art Development Agency dedicated to neuroaesthetics and dyspraxic practice. Declaration is Art with Heart’s contribution to this necessary work.

Emmott first started thinking about the show two years ago. Her previous plays and small-scale performances had “always been wrapped up in fiction: there have been elements about my life but they have been really creatively reworked”. Whereas Declaration is 100% autobiographical, and sets out to convey how ADHD feels, “really nailing down what it is, because it’s all inside my head and it’s making me feel different every day. So trying to articulate it into either a personification of something, or an energy or a song, the different senses and ways that we can show how it feels – because it’s a whole messy ball of scribble that you don’t really understand.”

Getting to that place, says Moorhouse, took over a year, and “has revolutionised how we work as a collective, because we’ve had to be so honest with one another in a rehearsal room about what we need”. That honesty has worked both ways: Moorhouse has OCD, and says: “There are ways in which that helps me, there are ways in which my work is better for that, and there are ways in which it disables me from doing things”. Over the making period the duo developed a shared language for describing the distractedness or brain loops that required the other’s accommodation and support.

It also led them to open up their rehearsal room for the first time. Much of the making of the show took place during an artist development residency at the Lowry, where Art with Heart are associates, and every Friday members of staff (not just in programming but box office and finance), along with friends and other artists, were invited in to give feedback on different sections of the work. “Sometimes it was useful practical things,” says Moorhouse, “such as Sarah needing seven people to ring bells to know that that section works and made sense to people. Sometimes we needed to show them how one section went into another: with the rollercoaster of emotions, we were really cautious that it shouldn’t feel like too much for people. Sometimes it was horrible doing 10 minutes and people’s response being ‘I found that interesting’, and us saying: ‘Oh god, that wasn’t what we wanted’. But having that feedback was great, it felt like a really collaborative process.”

The experience expanded the thinking the duo were already doing about their relationship with their audience, and particularly access needs, from making sure to provide ear defenders for those who struggle with sensory processing, to addressing the anxiety that might be inspired by the performance taking place in the round. On tour, the auditorium is being opened up 15 minutes before the show starts, to give people time to familiarise themselves with the room, and with Emmott, who chats with the audience throughout this time, introducing people to each other. “It makes sure everyone feels comfortable, because when you have audience interaction, it’s quite exposing,” says Emmott. “A lot of people, when I ask them ‘What’s your name?’ say: ‘I don’t do interacting’. And what’s interesting is that most of those people afterwards say to me: ‘I wish I hadn’t said that, because actually it was safe’.”

What the audience might need after the show has also been a paramount consideration, leading the duo to establish a well-being room that tours with the show, shaped and hosted by a qualified mental health practitioner, Steph Walker. They chose Walker specifically, says Moorhouse, because she has “a really holistic approach to well-being: she recognises the importance of medication for some people, but also the huge spectrum of what people need”. While many shows hand out the telephone numbers for national helplines such as Mind and that’s it, Walker offers not only those leaflets but a list of local support services that includes “the arts stuff, the green spaces, the walking groups. For some people that’s what they need, permission to take a day off and go on a bike ride again. Even if you’re taking drugs you still need that: drugs aren’t the answer completely, you need everything.”

One of the activities in Art with Heart’s rehearsal room

In five years of thinking about the post-show offer to audiences, Declaration‘s well-being room is among the best I’ve encountered: a model of practical generosity. Walker hands out teas and biscuits, guides people to activities designed to encourage people to consider how they might open space in their lives to talk about and act upon what their minds need, but also keeps plenty of space open in the room itself for conversation – and provides colouring sheets so you can eavesdrop on others without feeling weird. The night I saw the show, in Barnsley, one group of people were comparing their experiences of living with children with ADHD, while two older men shared tales of surviving alcoholism and overdose. It was an extraordinary indication of the connections and dialogues theatre could help forge, if only it put real effort into looking after its audience.

The advantage of Walker touring with the show for the audience is that she’s also on hand as a counsellor for Emmott. This is a key component of the well-being contract drawn up for the show, which has required every theatre on the touring schedule not to operate by the usual one-size-fits-all systems – and has changed the touring schedule itself, spreading it over a longer period to ensure that Emmott never has to perform more than three shows in a week. Every performance day begins with the team checking in, with each other but in particular with Emmott: “We ask how do you feel, are you able to do the performance – and we’ve got a clause in all our contracts with venues to say if Sarah isn’t able to do it, it’s not happening,” says Moorhouse. “Some venues have been surprised by that but no one’s said no to it, which has been really progressive.”

The potential financial pressure of this clause is accounted for in the budget, with a contingency to cover venues who can’t foot the bill of a cancellation. More importantly, the pressure on Emmott to perform is alleviated: “When you’re making something that’s autobiographical and particularly ongoing – this isn’t something retrospective that I’ve packaged up in my mind – it’s hard. If I’m having a really bad day, I’m already feeling very vulnerable, and to be in an exposing space with people I don’t know is going to be really counteractive. So being able to have that one line in place, a clause that says if I really can’t do it I don’t have to, and if it’s in the middle of the performance and I’ve said I’ll try but I get halfway through and I can’t, I can bow out, completely removes the pressure. And having it has basically meant I will probably never use it: because I know it’s there, my brain is relaxed, I know it’s OK to be me in that environment. It’s for me to protect myself and protect the next few months.”

The duo admit to a lot of fear when putting this provision together: that the budget was too big to be accepted by the Arts Council, that they were saying no to venues they had wanted to tour to for a long time. But saying no is something artists need to get better at doing, says Emmott. “It’s about giving yourself permission,” says Moorhouse. “You need to give yourself permission to say what you need. People will write into a budget that they need money for their physical theatre company to get physio treatment: you need to put in a well-being contingency for your brain.” And both hope that “by us doing it, other people will feel like they can”.

It takes barely any effort to imagine what the likes of the Sun and the Daily Mail would make of all this, let alone a government that demands art deliver economic return and that has been steadily stripping mental health services of funding. And yet, the duo are clear that they wouldn’t be doing all this work if it were for Emmott’s benefit only. “There’s no point in talking about your life and your experiences just to do it,” she says. “There has to be a point to it and that point has to be about the audience, about them taking it and saying, how does that apply to me, how can I look at myself, how can I challenge myself?” That doesn’t just mean people who recognise their own or their partner’s or their child’s ADHD in the show, but people who relate to the descriptions of anxiety, or of going to the doctor and hitting a brick wall.

And this is the point, Emmott emphasises: what she’s talking about isn’t a clearly defined thing but a spectrum of experience. “We have to think about it [neurodiversity and mental health] on an individual basis, and that’s what health services don’t allow.” Among the most enthusiastic responses to the show, says Moorhouse, have been people grateful that “Sarah celebrated the positives of ADHD – because some people might be on that spectrum but they don’t see it as a disorder or a disability. But none of our services are person-centred or spectrum-based: they’re all about the boxes, and that doesn’t work.”

She could, of course, be talking about the theatre industry too, its expectation that all artists tour the same way, make work the same way. But the duo are already seeing changes provoked by the well-being provision it’s shaped: the Lowry is looking at how it can provide a post-show well-being space for more of its performances; in Alnwick the Playhouse is going to open a similar space regularly as part of dementia-friendly performances; and younger artists the duo know are starting to build self-care into their contracts. Plus there’s the potential ripple effects that come with commissioning and budgeting for me to see the show and write this piece, and the ADHD awareness training sessions Art with Heart have been running, delivered by the ADHD Foundation and “attended by everyone from people working in youth offending services (there’s an incredibly high rate of ADHD diagnosis in prisons), teachers, youth workers, arts facilitators, and mental health support workers. We hate the words ‘social change’ because it feels like everyone’s using that,” says Moorhouse, “but that’s the core for every project we do. The link is that there is some form of shift for the participants or the people involved.” With Declaration, the shifts are much wider than the personal: they’re within venue-artist-audience relationships – and that’s an incalculably valuable thing.

Declaration is currently on tour, calling in at theatres including The Lowry, Salford (24th June) and The Black-E, Liverpool (1st July) – full info here.

Maddy Costa writes about theatre and music, as much as possible at the same time. Preferably with a recipe included. An occasional contributor to the Guardian, she found one blog (Deliq) wasn't enough, so now co-hosts four. She is critical writer, or critic in residence, or embedded critic, with Chris Goode & Company; through her work with them, and with Dialogue, the organisation she co-founded with Jake Orr, she is attempting to rethink the relationship between people who make, watch and write about theatre. At least once a week she decides she should stop writing about theatre and do something more useful instead.